Healthcare Provider Details

I. General information

NPI: 1093668253
Provider Name (Legal Business Name): JORDAN REGALADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8723 SIERRA COLLEGE BLVD
GRANITE BAY CA
95661-5990
US

IV. Provider business mailing address

8723 SIERRA COLLEGE BLVD
GRANITE BAY CA
95661-5990
US

V. Phone/Fax

Practice location:
  • Phone: 916-569-0861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: